Doctor Name: | MARY MONICA WEBER |
NPI Number: | 1013022367 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 428-123 |
Business Practice Address: | 1220 Mound Ave Ste 301 Racine, WI - 534043350 |
Business Phone Number: | 2626333591 |
Business Fax Number: | 2626332619 |
Mailing Address: | 6121 S 60th St, Apt 2 GREENDALE |
State: | WI |
Postal Code: | 531291903 |
Phone Number: | 4144214417 |
Fax Number: | |
NPI Enumeration Date: | 08/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | 09/29/2006 |
NPI Reactivation Date: | 11/03/2006 |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 428-123 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |